TransMed
Minimally Invasive Rib Removal:
Obtaining A More Feminine Torso
Through a New Surgical Technique |
By Sheila Kirk, M.D and Dr. Ernest Manders |
Perhaps a year ago, I wrote an article wherein I brought the subject of
rib removal once again into view. In that publication, I held a cautious
view and perhaps influenced many to reject the thought that such a
surgical procedure ought not to be considered. In the months to follow a
very innovative and successful technique was originated and demonstrated
to be successful and safe.
One of my associates, Dr. Ernest Manders, a
plastic & reconstructive micro-surgeon, examined the surgical technique
performed in the past and has developed a much more effective and cosmetic
procedure which is now in the list of surgeries our Transgender Surgical
and Medical Care Center offers. Many questions have been raised about this
body contouring surgery: its effectiveness, safety and details of its
performance and recovery. We want very much to give this information to
those interested.
The Human rib has long been a source of bone for reconstructive surgery in
other parts of the body. Here at TSMC, Dr. Manders has perfected a method which allows for removal of the
lowermost ribs, the 11th and 12th on both sides, through a small one inch
incision on either side of the spinal column.
The long, unsightly
incisions, formerly used, are eliminated. Instruments have been developed
to accomplish this. Endoscopy visualization with very little body
intrusion is used a great deal of the time but not exclusively. We
believe that the narrowed and tapered effect to the MTF's waist adds
greatly to create a shapely, more feminine torso.
Ribs eleven and twelve on both sides of the rib case are called "floating"
because their only attachment to other body structure is at the spinal
column. They are not attached with cartilage to the ribs above or to the
sides of the chest bone called the sternum. They are the very lowest of
those ribs forming the rib cage and tend to be shorter and less developed
than those that protect the lungs and heart and the great vessels inside
the chest. In their anatomic positions, while they lay over portions of
the liver and spleen on either side the protection afforded is much less
than one may think. Over the liver the 7th and 8th ribs are much more
involved with shielding this organ. Over the spleen on the left side, the
8th, 9th and 10th ribs afford more protection than those below them. In
fact the 12th rib offers nothing at all to this organ. On both sides, the
diaphragm, the very large muscle involved with breathing covers these
organs quite notably.
When one looks at the anatomic and physiologic concepts so completely
studied by medical research writers in basic scientific study, another
very important consideration is explained. The action of the lowermost
11th and 12th ribs is not involved in the important first phase of
breathing or inspiration. In fact, they act with the abdominal
musculature to antagonize the very activity of all the other ribs of the
thoracic cage. The prime function in respiration of all the ribs and the
chest bone is to allow chest expansion and increase chest cage space to
allow for increased lung volume in inspiration. The diaphragm descends to
aid this process. Abdominal wall muscles and the floating ribs work
against the physiologic function. Hence removal of them will facilitate
respiration, not impede it, and even increased lung activity as in
exercise is not interfered with or compromised.
Some have worried over the permanence of this procedure, concerned that
ribs grow back and that the waist will revert to the same pre-operative
contour. Experience in all the years the ribs have been removed for other
reconstructive surgery shows that while growth or regeneration can take
place it is minimal and proceeds from where the rib was divided at the
original incision site. In our pioneered procedure, this is at the back
one inch from the spinal column. If regrowth occurs at all, only small
nipples of bone over many years will be evident. And if it occurs, it
will follow the course of the periosteal covering originally enclosing it
at a very, very slow growth rate. Bone will not grow from other tissues
along the course of the rib and we can expect any re-appearance will
merely re-inforce the new tapered configuration as it was intended. The
actual performance of the surgery has to do with separation of the ribs
from a sleeve or sheath known as periosteum. Once freed of this tissue and
resected in the back on either side, the ribs are virtually slid out of
that covering. The procedure is done under general anesthesia and the
patient is kept in the hospital for 24-48 hours. Pain relief with various
techniques is very effective and home recovery is not prolonged.
Years ago, previous experience with rib removal produced very favorable
body contouring results but left unsightly and long, obvious scarring.
With TSMC's pioneering procedure, very small incisions as well as new
instruments and technique make the procedure a much more feasible
operation. Not all patients can be considered good candidates.
Pre-existent lung disease, heavy smoking and obesity could eliminate a
number of individuals but a distinct number of people can find reward in
their appearance, when this procedure is done for them.
We welcome questions and opportunity to discuss this new technique and to
give more clarification. Call us at (412) 781-1092 if you wish to discuss
with us this approach more thoroughly.
Ernest K. Manders, M.D.
Sheila Kirk, M.D.
Drs. Kirk and Manders are two of three principal surgeons performing
Genital Reassignment Surgery and related Trans surgeries at the first
Transgender Surgical & Medical Center (TSMC) developed and directed by a
Trans surgeon. You can receive more information about the TSMC Center
located in Pittsburgh, PA or ask Dr. Kirk questions on your treatment and
care, by contacting her at TSMC@aol.com, by phone (412) 781-1092, fax
(412) 781-1096 or snail mail: TSMC P.O. Box 38366, Blawnox, PA 15238.
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